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Obesity Dyslipidemia And The Metabolic Syndrome PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "OBESITY, DYSLIPIDEMIA AND THE METABOLIC SYNDROME".

This medical PowerPoint presentation talks about Obesity, dyslipidemia, and the metabolic syndrome, all interrelated conditions that can significantly increase a persons risk for a variety of health problems.

Obesity, dyslipidemia, and metabolic syndrome are all closely linked, with each condition increasing the risk for the others. For example, obesity can lead to dyslipidemia and insulin resistance, both of which are components of metabolic syndrome. Dyslipidemia can also contribute to insulin resistance and metabolic syndrome. Therefore, it is important to address these conditions through lifestyle changes, such as exercise and a healthy diet, as well as through medical treatment when necessary.

Tags : Obesity, dyslipidemia, metabolic syndrome, insulin resistance, endocrinology, endocrinology PowerPoint presentation

Published on : Apr 18, 2023 | Views : 1113 | Downloads : 3

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Slide 1-

Advocate Heart Institute OBESITY, DYSLIPIDEMIA AND THE METABOLIC SYNDROME Vincent Bufalino, MD Senior Vice President – Advocate Heart Institute Senior Medical Director of Cardiology - AMG
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Evolution 2
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Obesity is defined as a BMI of ≥30.0. Source: Health, United States, 2009 (NCHS). Roger VL et al. Circulation 2011. Circulation. 2011;123(4):e18-e209. The Obesity Epidemic 3
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Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) www.cdc.gov/obesity/data/trends.htm . Accessed Feb 3, 2010. 4 1999 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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BMI and Prevalence of Metabolic Disease NHANES 1999-2002 Body Mass Index (BMI) Bays HE, et al. Int J Clin Pract. 2007;61:737-747. Bays HE. Am J Med. 2009;122(1 suppl):S26-37. 18.5-24.9 25-26.9 27-29.9 30-34.9 35-39.9 40 0 10 20 30 40 50 60 70 Diabetes Mellitus Hypertension Dyslipidemia OVERALL <18.5 1.7 22.3 24 4.2 17.6 38.2 5.7 25.3 53.1 10.1 30.8 62.2 12.2 39.3 68 16.4 44 67.5 27.3 51.3 62.5 9 28.9 52.9 Body Mass Index (BMI) % of Patients Lean Normal Overweight Obese 5
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Obesity-related Hypertension: Pathogenesis, Cardiovascular Risk, and Treatment -- A Position Paper of The Obesity Society and The American Society of Hypertension Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, et al. Obesity (Silver Spring, Md). 2013;21:8-24. 7
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Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by American Association of Clinical Endocrinologists and The Obesity Society Gonzalez-Campoy JM, et a. Endocr Pract. 2013. Vol 19 (Suppl 3). “Primary disturbances in adipose tissue anatomy and function, adiposopathy, are etiologic in the development of . . . metabolic derangements” “Thus, . . . a major focus of nutrition counseling for overweight or obesity is to correct adiposopathy” “Nutrition counseling for overweight and obesity should be aimed to decrease fat mass and also to correct adipose tissue dysfunction (adiposopathy)” 8
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Definition 9
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Metabolic syndrome: The NCEP ATP III definition* *2001, updated 2005 Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. Circulation. 2002;106;3143. 10
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IDF Worldwide Definition of the Metabolic Syndrome. www.idf.org/metabolic_syndrome 11
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Adapter from Grundy SM. J Clin Endocrinol Metab. Jun 2004;89(6):2595-2600. Slide Source: Obesityonline.org Obesity and Metabolic Syndrome: A Cluster of Coronary Heart Disease Risk Factors 12
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Bays HE. JACC 2011;57:2461-73. Contribution of Adipose Tissue to Metabolic Syndrome and CVD Risk 13
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Bays H, Ballantyne C. Future Lipidology. 2006;1:389-420. Kalant D, et al. Can J Diabetes. 2003;27:154-171. Pausova Z. Curr Opin Nephrol Hypertens. 2006;15:173-178. Landsberg L. Cell Mol Neurobiol. 2006;26:497-508. Yu YH, Ginsberg HN; Circ Res. 2005;96:1042-1052. Metabolic Syndrome: Mechanisms 14
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Bays HE, et al. Int J Clin Pract. 2007;61:737-747. Bays HE. Am J Med. 2009;122(1 suppl):S26-37. BMI Among Patients With Metabolic Disease NHANES 1999-2002 18.5 Body Mass Index (BMI) 18.5-24.9 25-26.9 30-34.9 35-39.9 40 27-29.9 Lean Normal Overweight Obese 15
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Age-Specific Prevalence of the Metabolic Syndrome Ford E et al. JAMA 2002;287:356-359. 8814 US adults from NHANES III Survey, 1988-94 16 Data are presented as percentage (SE)
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Prevalence of the NCEP Metabolic Syndrome: NHANES III by Sex and Race/Ethnicity Ford ES et al. JAMA 2002;287:356-359. Prevalence, % Men Ford ES et al. JAMA 2002;287:356-359. Women 25% 16% 28% 21% 23% 26% 36% 20% 17
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Prevalence of CHD by the Metabolic Syndrome & Diabetes in the NHANES Population Age 50+ Alexander CM et al. Diabetes 2003;52:1210-1214. % of Population = No MS/No DM 54.2% MS/No DM 28.7% DM/No MS 2.3% DM/MS 14.8% 18
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Cardiometabolic Risk:Metabolic Syndrome Associated With Increased CV Morbidity and Mortality Isomaa B, Almgren P, Tuomi T, et al. Diabetes Care. Apr 2001;24(4):683-689. * Cardiovascular mortality was defined using ICD-9 (codes 390-459) before 1997 and ICD-10 (codes 100-199) thereafter, 19
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Courtesy of Prof. Yuji Matsuzawa, Osaka, Japan 20
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Large insulin- resistant adipocyte Adrenergic receptors  Insulin-mediated antilypolysis Catecholamine- mediated lipolysis  All Fat Cells Are Not Created Equal 21
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Diet Physical activity/ Fitness Socioeconomic status Birth size, childhood growth Genes Hypertension M E T A B O L I C S Y N D R O M E Hypercoagulability, impaired fibrinolysis Hypoandrogenism (men), Hyperandrogenism (women) Endothelial dysfunction Hyperuricemia Adipose hormones Inflammation Abdominal obesity/ Ectopic fat deposition Insulin resistance/ Hyperinsulinemia Overweight Diabetes CVD Dyslipidemia Low HDL, high TG High ApoB, low Apo A Small dense LDL Elevated fasting or 2-h post-load glycemia 22
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Dagenais GR, Yi Q, Mann JF, et al. Am Heart J. Jan 2005;149(1):54-60. Cardiometabolic Risk:Abdominal Adiposity Is Associated With Increased Risk of CV Events 23
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Risk of Major CHD Event Associated with High Insulin Levels in Non-diabetic Men Pyörälä M, et al. Circulation. 1998;98:398–404. Q1 to Q5=quintiles of area under the curve (AUC) insulin (Q1=lowest quintile; Q5=highest quintile). Proportion without major CHD event Kaplan-Meier Survival Curve 24
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Coronary HeartDisease Mortality 0 2 4 6 8 10 12 0 5 10 15 20 RR (95% CI),3.77 (1.74-8.17) Follow-up, Y Cumulative Hazard (%) Yes No 866 288 852 279 834 234 292 100 Unadjusted Kaplan-Meier Curve No. at Risk Metabolic Syndrome 0 2 4 6 8 10 12 RR (95% CI),3.55 (1.96-6.43) Follow-up, Y 866 288 852 279 834 234 292 100 0 2 4 6 8 10 12 RR (95% CI),2.43 (1.64-3.61) Follow-up, Y 866 288 852 279 834 234 292 100 CardiovascularDisease Mortality All-causeMortality Yes Metabolic Syndrome: No Lakka H-M, et al. JAMA. 2002;288:2709-2716. 25
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Treatment 26
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“Aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves quality of life for these patients.” Smith (2006). AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update. Circulation © 2006 American Heart Association, Inc. 27
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Ideal CV Health Ideal Health Behaviors Metric (ALL) • Nonsmoking • Healthy Weight • Appropriate Levels of Physical Activity • Healthy Eating Pattern Ideal Health Factors Metric (ALL) • Total cholesterol • Blood pressure • Nondiabetic © 2010, American Heart Association. All rights reserved. 29
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Life’s Simple 7 Never smoked or quit more than one year ago Body mass index less than 25 kg/m2 Physical activity of at least 150 mins (moderate intensity) or 75 mins (vigorous intensity) each week Four to five key components of a healthy diet consistent with current AHA guidelines Total cholesterol of less than 200 mg/dL Blood pressure below 120/80 mm Hg Fasting blood glucose less than 100 mg/dL 30
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Healthy Diet(4-5 Dietary Goals met) Fruits and vegetables: ≥4.5 cups per day Fish (preferably oily): ≥2 3.5-oz servings per week Fiber-rich whole grains (1.1 grams fiber per 10 grams carbohydrate): ≥3 1-oz-equivalent servings per day Sodium: <1500 mg per day Sugar-sweetened beverages: ≤450 kcal (36 oz) /week Other Dietary Measures Saturated fat: < 7% of total energy intake Nuts, legumes, and seeds: ≥ 4 servings/week Processed meats: ≤ 2 servings/week 31
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CV Health Metric Definitions* Poor Intermediate Ideal * The average net percentage of people who move up one level of health Goal: 20% overall improvement 32
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Lifetime Risk: Age 50 Lloyd-Jones, Circulation 2006 2 Major RFs 1 Major RF 1 Elevated RF 1 Not Optimal RF Optimal RFs Men Attained Age Adjusted Cumulative Incidence 5% 36% 50% 69% 46% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 50 60 70 80 90 Attained Age Women 8% 27% 50% 39% 39% Adjusted Cumulative Incidence 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 50 60 70 80 90 33
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My Life Check Assessment 34
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My Life Check Assessment 35
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Nutritional Therapy Energy consumption intended to cause negative caloric balance and fat weight loss Low calorie diet is often described as 800 – 1500 kcal/day Very low calorie diet is often described as <800 kcal/day Restricted dietary carbohydrate Restricted dietary fat Very low calorie diets 36
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Physical Activity Assist with weight maintenance Assist with weight loss Improve body composition Improve metabolic health Improve musculoskeletal health Improve cardiovascular health Improve pulmonary health Improve mental health Improve sexual health Adiposopathy (Sick Fat Disease) Non-adipose Health Parameters 37
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Physical Activity Moderate exercise = 70 minutes per week Vigorous exercise = 150 minutes per week Percent body fat better assessment of body composition than BMI Emphasize “core” muscle exercise Aerobic Anaerobic Priority is to increase energy expenditure 38
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Exercise and the Heart  LDL Cholesterol  Weight  Hypercoagulability  Atherosclerosis Preferential loss of abdominal fat Reduces CRP  Insulin resistance  HDL Cholesterol  Skeletal muscle glycogen transport  Rate & amount fat oxidation at rest 40
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Behavior Therapy Frequent encounters with medical professional or other resources Education 41
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Weight Management Pharmacotherapy Facilitate management of eating behavior Slow progression of weight gain/regain Improve the health, quality of life, and body weight of the obese and/or overweight patient Adjunct to nutritional, physical activity, and behavioral therapies 42
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Pharmacotherapy Phentermine Diethylpropion Phendimetrazine Benzphetamine Orlistat Lorcaserin Phentermine HCI/Topiramate extended-release Approved < 1999 2012 and Beyond 43
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Weight Loss 44
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Glucose Management 45
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Blood Pressure Management 46
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Lipid Management 47
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Comprehensive Management 48
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Is Eugastrosis (a Normal Stomach) a Disease? Gastric Band Gastric Sleeve Roux en Y Gastric Bypass 49
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Conclusions Obesity is increasing worldwide at an alarming rate Adiposopathy leads to atherogenic dyslipidemia as well as several other risk factors for CAD 7%-10% weight loss significantly affects CHD risk Calorie restriction is the most important criteria for the diet Increased physical activity is also critical Many drugs can contribute to weight gain Surgical and pharmacologic therapies can be helpful in selected patients 50
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THANK YOU 51